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The following is the exact verbiage from my 9/23/94 neuro-exam summary letter that secured my getting Social Security Disability Insurance. No further documentation was needed by Social Security to process the claim. Please note that a woman who is a Disability Analyst, per the City of Santa Rosa's direction, also assisted me. She told me that we would be turned down at least once; she was amazed to see the whole process over in a few months. My neurologist was reluctant to call me disabled since he hadn't seen me when I was truly ""switched off"'. Hope this helps someone out there. ---------------------------------------------------------------------------- -------- 9/23/94 neuro-exam HPI: This is a revisit for this 36 y.o. man with Idiopathic Parkinson's Disease. He has been followed with a diagnosis for some four years, and has in retrospect had symptoms extending back some seven years. Thus symptom onset was at age 29 years. Since diagnosis, he has been followed regularly in this department and has shown disease progression. However, all visits to me have been while he was actively taking Sinemet and Eldepryl. He comes today without having taken any medication since last evening. His usual medication schedule consists of Eldepryl 5 mg, 2 daily, and Sinemet 25/100, 5 to 7 daily. Note is made of his recently negotiated disability retirement from the employ of the City of Santa Rosa. He (and the City's disability insurance carrier request certification of his disability so that he will qualify for total and permanent disability as well as for a blue parking placard. Exam: This is a w/d w/n man in no distress. He has not taken his medication this date. Facial masking is evident, as is a very "slack" mouth and minimal drooling. Voice is hypophonic and subtly slurred. A stooped posture is evident on standing and walking; steps are small and shuffling, and no associated arm swing(of either UE) is noted. He is unstable with attempted rapid turns as he walks to and fro; he turns "en bloc". There is a very prominent nearly continuous rest tremor of the RUE. There is cogwheel rigidity of both UEs, R far more prominent than L. Imp: Idiopathic Parkinson's Disease. In contrast to previous observations and evaluations, I now believe (having see n the patient after only missing one dose of medicine) that he is indeed disabled completely and permanently from future employment. This is due to rather dramatic motor fluctuations which are now evident. , and were not evident in the past (he always wanted to appear at his best). Even part-time work is problematic because there is not a guarantee of consistent and predictable "on" time, even with very consistent dosing intervals. Thus I concur (after the fact) with the wisdom and appropriateness of his medical retirement. Parkinson's Disease is a degenerative disease and will predictably worsen steadily for the rest of his life. Therefore he should not be able to return to work, ever. Rec: I agree with the appropriateness of his medical retirement. I agree that he merits a "Disabled" parking placard and have filled out and signed the appropriate paperwork. He should for now continue his Sinemet and Eldepryl unchanged. The possibility of adding a Dpoamine Agonist (such as Bromocriptine) is again discussed. This will be addressed further in the future. A recheck visit is suggested for 3 to 4 months; he is welcome to call sooner as needed (my Neurologist's name here)